401k Plan data: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST plan

PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 401k Plan overview

Plan Name	PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST
Plan identification number	001

PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

PACIFIC COAST PERFUSION GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC COAST PERFUSION GROUP, INC.

Employer identification number (EIN): 954488278

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 JOSEPH A. BERENDT JR. 2015-03-01
001 2013-01-01 JOSEPH A. BERENDT JR. 2014-08-26
001 2012-01-01 JOSEPH A. BERENDT JR. 2013-06-17
001 2011-01-01 JOSEPH A. BERENDT JR.
001 2010-01-01 JOSEPH A. BERENDT JR.
001 2009-01-01 JOSEPH A. BERENDT JR. JOSEPH A. BERENDT JR. 2010-08-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	JOSEPH A. BERENDT JR.	2015-03-01
001	2013-01-01	JOSEPH A. BERENDT JR.	2014-08-26
001	2012-01-01	JOSEPH A. BERENDT JR.	2013-06-17
001	2011-01-01	JOSEPH A. BERENDT JR.
001	2010-01-01	JOSEPH A. BERENDT JR.
001	2009-01-01	JOSEPH A. BERENDT JR.		JOSEPH A. BERENDT JR.	2010-08-13

Plan Statistics for PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST

401k plan membership statisitcs for PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST

Measure Date Value
2011: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 4
Number of participants with account balances 2011-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 4
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 4
Number of participants with account balances 2010-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 4
Number of participants with account balances 2009-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	4
Number of participants with account balances	2011-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	4
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	4
Number of participants with account balances	2010-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	4
Number of participants with account balances	2009-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST

Measure	Date	Value
2011 : PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$30,192
Expenses. Total of all expenses incurred	2011-12-31	$15,736
Total plan assets at end of year	2011-12-31	$420,452
Total plan assets at beginning of year	2011-12-31	$405,996
Value of fidelity bond covering the plan	2011-12-31	$40,000
Total contributions received or receivable from participants	2011-12-31	$10,600
Expenses. Other expenses not covered elsewhere	2011-12-31	$15,736
Other income received	2011-12-31	$13,295
Net income (gross income less expenses)	2011-12-31	$14,456
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$420,452
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$405,996
Total contributions received or receivable from employer(s)	2011-12-31	$6,297
2010 : PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$67,496
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$405,996
Total plan assets at beginning of year	2010-12-31	$338,500
Value of fidelity bond covering the plan	2010-12-31	$40,000
Total contributions received or receivable from participants	2010-12-31	$33,550
Other income received	2010-12-31	$20,704
Net income (gross income less expenses)	2010-12-31	$67,496
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$405,996
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$338,500
Total contributions received or receivable from employer(s)	2010-12-31	$13,242

Form 5500 Responses for PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST

2011: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: PACIFIC COAST PERFUSION GROUP, INC. EMPLOYEES 401K PROFIT SHARING TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80942 )

Policy contract number

C2512400W

Policy instance

Insurance contract or identification number	C2512400W
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

1007453732

Policy instance

Insurance contract or identification number	1007453732
Number of Individuals Covered	4
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $15,567
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80942 )

Policy contract number

C2512400W

Policy instance

Insurance contract or identification number	C2512400W
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,857
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,857
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER FEES
Insurance broker organization code?	4
Insurance broker name	CHRISTOPHER L. GERWIN

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Company Name:	PACIFIC COAST PERFUSION GROUP, INC.
Employer identification number (EIN):	954488278
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners